Organization
FORM ORTHOTICS & PROSTHETICS, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICAH ALFORD L/CPO (FOUNDER)
(402) 212-7878
Entity
Organization
Contact information
Practice address
4921 E STATE ST LOWR LEVEL, ROCKFORD, IL 61108-2275
(402) 212-7878
Mailing address
4921 E STATE ST LOWR LEVEL, ROCKFORD, IL 61108-2275
Taxonomy
Speciality
Code
Description
License number
State
335E00000X
Prosthetic/Orthotic Supplier
Primary
—
—
Other
Enumeration date
06/04/2026
Last updated
06/04/2026
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